Oral contraceptive use and risk of suicidal behavior among young women
(2022) In Psychological Medicine 52(9). p.1710-1717- Abstract
Background. Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association. Methods. We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide.... (More)
Background. Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association. Methods. We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide. Results. In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73-2.78 after 1 month of use, and 1.25-1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period. Conclusions. Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.
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- author
- Edwards, Alexis C. LU ; Lönn, Sara Larsson LU ; Crump, Casey LU ; Mościcki, Eve K. ; Sundquist, Jan LU ; Kendler, Kenneth S. and Sundquist, Kristina LU
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cohort study, Oral contraception, Registry data, Suicidal behavior
- in
- Psychological Medicine
- volume
- 52
- issue
- 9
- pages
- 1710 - 1717
- publisher
- Cambridge University Press
- external identifiers
-
- scopus:85094217200
- pmid:33084550
- ISSN
- 0033-2917
- DOI
- 10.1017/S0033291720003475
- language
- English
- LU publication?
- yes
- id
- 90544d6d-be93-4118-9b80-58b14aec2fb4
- date added to LUP
- 2020-11-12 07:14:33
- date last changed
- 2024-06-27 01:13:42
@article{90544d6d-be93-4118-9b80-58b14aec2fb4,
abstract = {{<p>Background. Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association. Methods. We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide. Results. In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73-2.78 after 1 month of use, and 1.25-1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period. Conclusions. Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.</p>}},
author = {{Edwards, Alexis C. and Lönn, Sara Larsson and Crump, Casey and Mościcki, Eve K. and Sundquist, Jan and Kendler, Kenneth S. and Sundquist, Kristina}},
issn = {{0033-2917}},
keywords = {{Cohort study; Oral contraception; Registry data; Suicidal behavior}},
language = {{eng}},
number = {{9}},
pages = {{1710--1717}},
publisher = {{Cambridge University Press}},
series = {{Psychological Medicine}},
title = {{Oral contraceptive use and risk of suicidal behavior among young women}},
url = {{http://dx.doi.org/10.1017/S0033291720003475}},
doi = {{10.1017/S0033291720003475}},
volume = {{52}},
year = {{2022}},
}